Help please - consultant refused ELCS

[AnotherWeekAnotherName]

I had an appointment with the consultant today (I am 28 weeks with 1st baby) and it was awful. I have barely been able to function since because I am so stressed out. I have requested an ELCS on mental health grounds because I was sexually assaulted in my teens and have found the idea of a vaginal delivery very triggering. I started a previous thread about it here.

He was adamant that he wouldn't grant a section on these grounds. This caught me completely off guard because everyone else I had spoken with in the run-up (midwife, registrar, and consultant midwife) had been really supportive. The consultant was extremely dismissive of my reasons for requesting a section, and his lack of compassion verged on aggressive. He told me I was trivialising the risk of a section without discussing my views on the risks at all. When I stated that I couldn't accept the idea of giving birth vaginally, he barked back 'can't or won't?'.

Eventually he accepted that I could see anther consultant to get a second opinion, but then proceeded to tell me that if I did get an ELCS he would write all over my notes that if I went into early labour (i.e. before date of booked section) I was not to get a section.

One of the worst things is that I had heard previously that he was actually sympathetic to women who request a section. It just felt like he took against me and was being really vindictive. I now feel in a complete state of panic that I will not get the section I believe I need. At the very least I feel that any trust that had been built up between the hospital staff and me has completely gone.

Does anyone have any advice on what I could do next, and how I can approach the appointment with the next consultant?

Thank you both.

I've sent the complaint in today, but I don't think anyone will look at it on a Friday afternoon!

I'll give PALS a call on Monday to check they've got it and to ask about speeding up the process for the second opinion.

I am sure you will hear back soon. Try to relax this weekend - easier said than done I am sure!

OP I'm so sorry you've experienced this. Definitely send in your complaint if you haven't yet. PALS is usually really great at sorting things out and hurrying things through for people where there have been mistakes.

That consultant sounds like a total arse and shouldn't be working with women.

It's a good idea to get referred to the ante natal mental health support team too ASAP as their support for your c-section will be very hard for the medical team to overrule.

Thanks Curbside and Betty.

I am seeing the supervisor of midwives this week to discuss the complaint, and I also have an appointment with an alternative consultant on Friday, so I think my complaint has helped to get things moving. Thanks to everyone who urged me to do it - I don't think I would have had the guts otherwise.

I'm still feeling pretty anxious about whether or not I'll get the c section, but I feel like they have taken my complaint seriously at least.

Oh that's really good news. Well done for sending in your complaint. And good luck on Friday. Can you take DH or a friend with you?

Oh that's really good news, well done you. I second taking someone with you for both of those appointments if possible. Also think about taking some notes in the meetings and summarising out loud as you go along, so that everyone is on the same page.

Eventually he accepted that I could see anther consultant to get a second opinion, but then proceeded to tell me that if I did get an ELCS he would write all over my notes that if I went into early labour (i.e. before date of booked section) I was not to get a section.

Firstly, it is unethical and against doctors code of conduct to issue threats in order to 'persuade' you to behaviour a particular way and to bully you out of pursuing a particular type of treatment. If you have been told this, you should make an official complaint.

With respect he can write this on your notes, and it does not mean shit unless he also bullies staff. In which case you have a hospital where there is systematic and institutionalised bullying which is..., well its a recipe for wider problems.

I would be pointing out BOTH in any complaint made. Get it on the official record as it removes the issue of systematic institutional issues as any doctor intimidated by this jerk off will be given power by it and be more able to use their own professional judgement to ignore him as they are within their rights to do.

The 'can't or won't' comment is also at odds with ethics and is unacceptable. Under the NHS you have a right to be treated with respect and dignity. By saying this, he is not and is behaving in a bullying manner. It is also at odds with the research about why women ask for CS. And the NICE guidelines.

I would be asking the hospital to comment on the research available for too posh to push verses mental health reasons stemming from abuse in childhood and whether they consider his manner appropriate. He is actually risking causing harm to a vulnerable person by being dismissive and aggressive in his manner. Again this is against his oath to the NHS as a doctor.

That's three separate real issues in his conduct.

I would be also taking steps to seek out mental health support a) you say its ruining your whole life at the moment so you NEED it and b) it backs up your request for a CS and c) puts this doctor in a position where he is at risk of being show up as being a damaging force and contributing factor to damage to your mental health.

I would make sure you have this all written down for ANY and ALL future meetings relating to your health or the complaint itself.

Use official sources to quote from - eg what NICE says and what the GMC ethics code is. Its about throwing the book at them.

The fact this consultant face disciplinary action over his manner is separate from your request for a CS. PLEASE PLEASE bare this in mind. He can write all over your notes, but it can be over ruled at any time and they really have little weight.

PS if you need any help preparing today, I'll do my best to assist if you would like.

(As far as requests for ELCS go, your history is typical of women who do request in research btw and is therefore recognised as a pretty standard and legitimate reason for one)

Thank you Red - I think I did cover pretty much all of your points in my complaint, and I do think they are taking that side of things seriously. (I hope! I don't want him to behave like this to anyone else.)

I am seeing the supervisor of midwives later on today, and I am going to ask her to refer me to perinatal mental health. I was also going to ask her to make sure that the new consultant knows all of my history before the appointment tomorrow - she already asked me if she could share my complaint letter with her so I know she will have seen that, but I also wrote a letter explaining my reasons for wanting ELCS before my appointment with the consultant, which he didn't bother to read, and I would like her to have read that before the appointment too.

I saw a consultant midwife a few weeks ago who talked me through all of the risks of ELCS, so I'm going to make sure I'm really familiar with those before the appointment tomorrow, but I don't really know how else to prepare - I feel pretty overwhelmed and intimidated to be honest.

I had a really good experience throughout my pregnancy despite severe anxiety. Then I had a midwife make a home visit who pretty much bullied me and treated me like shit. We made a complaint. It was handled wonderfully. The people who dealt with the complaint were brilliant and understood the damage it had caused in destroying a lot of trust which others had worked so hard to build with me because of my previous history (which is different to yours).

Before seeing them, I had worked myself up into a right state. Precisely because of the damage caused. It does just take one bad apple unfortunately to undo the other 99's good work.

My point is just that though; everyone else you have seen to date has been good. Statistically and logically, if you were to record your experience so far based on everyone you had seen, you'd say that you were unlikely to face another dickhead. But emotionally its the idiot that stays in your head and dominates your thoughts. Keep putting it into that context until tomorrow if its bothering you.

Hopefully you will be fine and it will go well tomorrow. I do think the fact they are dealing with your complaint promptly is a good sign.

Incidentally, it turned out the midwife I complained about had 'issues' ongoing elsewhere. They wouldn't say any more (though there was an investigation that had been published in the press that week) so the midwife in question was under supervision. It wouldn't surprise me if you find that you are not the only person complaining about this person either...

In terms of prep for tomorrow my advice is to take copies of the letters you've written (the letter explaining why you want a ELCS and the complaint letter), also a printed copy of the fact sheet I shared up thread, and lastly make a note of the key points you want to make and questions you want to ask. So you can refer to it in your appointment and make sure you haven't forgotten anyway.

Armed with all that, you will be absolutely fine. If you feel nervous try concentrating on your breath (take some slow, deep breaths) and you could also visualise the appointment going really well. I think it will.

anything, not anyway!

Just wanted to update: I saw a lovely lovely consultant today, who really listened to me. She talked me through all of the risks again, and then let me make the decision. She has agreed to the section, which will be done at 39 weeks, and if I go into labour after 37 weeks, then she has written on my notes that I should be able to have an emergency cs. If I go into labour before that, it will have to be assessed at the time, which I can accept. Hopefully it won't happen, not least because I want the baby to be properly cooked before it comes out.

I feel so relieved I can't describe it. It was such a horrible burden worrying about the delivery and I feel like I can get on with things and enjoy being pregnant now.

Thank you all so much for your help - I really don't think I'd be in this position now if it weren't for all of your advice and support.

Yay! I'm so glad it went well today. I was hoping you would get a nice consultant - I wouldn't be surprised if they made sure of it after the arsehole you saw last time!

How did it go with the senior midwife person yesterday?

It was really helpful actually. She came to the appointment today for support and she is going to be my midwife in theatre when I have the section, so I have continuity of care. I get the impression that they really want to offer good care, and my experience last week was an unlucky blip, rather than the way things are iyswim.

She also asked me if I would help her to come up with a new policy to help people who have suffered sexual assault/abuse. I think I will do that - it would be good to be useful, if I can be (!) and I think it might help me to move on from the assault a bit as well - by doing something constructive as a result.

Oh that's fantastic. It sounds like they took your complaint very seriously and they are now giving you the considerate care you deserve

So pleased to see this has been sorted for you OP and I hope your initial consultant has the opportunity to reflect on his practice . Great to hear you'll be instrumental in changing policy too but take it slowly and make sure you feel able to debrief your experiences in a safe place if it gets too difficult for you.

That's fab news! I also got asked if they minded using my case anonymously to illustrate an issue to help with training and improving care for others in future when I made my complaint.

It really does prove that it is worth complaining and can be a positive thing to do.

I hope it really does make a difference to you and to policy in general in the long term.

There is research out there that suggests that a significant number of women who ask for an ELCS for a first pregnancy have a history of sexual assault/abuse and you are no means alone in doing so. It may be worth saying that you believe this to be the case and that has implications for how any woman asking for an ELCS should be treated as a rule.

I wish you all the best.

I'm so pleased for you op xx good luck

I've been watching this thread. So delighted for you OP. Well done. I can see Redtoothbrush whose advice to me was instrumental in helping me get my issues across properly so my ELCS could be agreed is at it again! Well done Red and everyone else for your wonderful advice and support with this lady too